6/22/2016 Region IX Western Clinicians Network Conference Harveys - - PowerPoint PPT Presentation

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6/22/2016 Region IX Western Clinicians Network Conference Harveys - - PowerPoint PPT Presentation

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6/22/2016 Region IX Western Clinicians Network Conference Harveys Lake Tahoe, Nevada June 14, 2016 The Built Environment & Health Design Avein Saaty-T afoya, MD MBA HCM EDAC President & Chief Executive Officer Adelante Healthcare

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Region IX Western Clinicians Network Conference

Harvey’s Lake Tahoe, Nevada June 14, 2016

The Built Environment & Health Design

Avein Saaty-T afoya, MD MBA HCM EDAC President & Chief Executive Officer Adelante Healthcare Board Member, Center for Health Design

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2 4 6 8 10 12 1998 2000 2002 2004 2006 2008 2010 Federal Grant Patient Revenue Other Grants Donations, Int

Sources of Support and Revenue

(in millions)

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Blue ocean

2013 2013

REST ESTRUCT CTURING OF OF HEALTHCARE

FOCUS ON PRIMARY CARE

SEISMIC CHANGES

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6/22/2016 6 ACA CA +3 +32M 2M

PEOPLE

50% 50%

PAID THROUGH MEDICAID EXPANSION

50 50%

PAID THROUGH HEAL TH INSURANCE EXCHANGES HEALTHCARE REFORM, LEGISLATION & THE BUILT ENVIRONMENT Malone, E., Taylor, E., et al. (2015). Quality Care, Legislation and Design: An Issue Brief on Healthcare

  • Reform. Concord, CA: The

Center for Health Design Topics, Healthcare Reform. https://www.healthdesign.org /topics/healthcare-reform Figure created by Ellen Taylor

THE HE HO HOLY GRAIL GRAIL

INSTITUTE FOR HEALTHCARE IMPROVEMENT

  • Improve the patient experience

QUADRUPLE AIM

  • Improve the health of populations
  • Reduce per capita cost
  • Improve provider engagement

GONE GONE FO FORE REVE VER

Marcus Welby, M.D.

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patient experience in ambulatory care: CAHPS surveys

https://cahps.ahrq.gov/qualit y- improvement/improvement- guide/1- about/index.html#about Two CAHPS Surveys

  • Health Plan (1997) –

experiences with health plans and their services

  • Clinician & Group (2007) –

experiences with health care providers and practice staff

CAHPS Ambulatory Care Improvement Guide: Patient Experience

https://cahps.ahrq.gov/quality-improvement/improvement-guide/improvement- guide.html

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TARGETED PATIENT EXPERIENCE IMPROVEMENT STRATEGIES

https://cahps.ahrq.gov/qualityimprovement/improve ment-guide/6-strategies-for improving/index.html#6a

AHRQ CAHPS Strategies Safety Net Clinic Redesign Recommendations

….Lots more design recommendations can be found in the report: Joseph, A., et al. (2009). Improving the Patient Experience: Safety Net Clinic Redesign. California HealthCare Foundation. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20File s/PDF/PDF%20S/PDF%20SafetyNetDesign.pdf

PC PCMH

RESTRUCTURING OF PRIMARY CARE

Hospital-based

  • utpatient

clinics Kaiser model

PCMH

Physician practices Community health centers & safety net clinics

RED

PA TIENT

PA TIENT- CENTERED CARE

HEALTH COACH NURSE PHARMACY PHYSICIAN

IMPROVED OUTCOMES EFFECTIVE COLLABORA TION IMPROVED DECISIONMAKING

MUL TIDISCIPLINARY

BEHAVIORAL HEAL TH NUTRITIONIST Gulwadi, G., Joseph, A., & Keller, A. (2009). Exploring the impact of the physical environment

  • n patient outcomes in ambulatory care settings. Health Environments Research & Design

Journal, 2(2), 21-41.

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AN EVIDENCE-BASED DESIGN MODEL Strategic Goals Improved patient, staff and resource outcomes

Research Disciplined Teamwork, Execution & Institutionalization Infrastructure Building Technology Furniture Equipment Re-engineered Clinical & Administrative Processes Trans- formational Leadership & Culture

AMBULATORY CARE PATIENT EXPERIENCE

Place (Infrastructure) People (Culture & Leaders) Process (Reengineering) Building Identify Desired End- State Refine Staff Care Processes Technology Develop Readmission Reduction Plan Engage Patients Furniture/Equipment Measure and Reward Progress Engage Loved Ones Involved in Care

Practice EBD Workshop Integrating EBD

DE DESIGN GN GOALS ALS

COLLABORA TIVE SPACES FOR CARE TEAM

SAFETY-NET CLINIC CARE MODEL

CLOSE TO EXAM ROOMS FLEXIBLE SPACES

Design: NBBJ

SPACE, FURNITURE, TECHNOLOGY TO SUPPORT GROUP INTERACTION EASE OF COMMUNICA TION BETWEEN STAFF VISIBILITY MINIMIZE NOISE (USE OF CARPET)

Design: Boulder Associates

DE DESIGN GN GOALS ALS

SAFETY-NET CLINIC CARE MODEL

INCREASE VISUAL CONNECTION BETWEEN WORKSP ACES PORTABLE DIAGNOSTIC EQUIPMENT TELEMEDICINE POINT-OF-CARE TESTING ELECTRONIC HEALTH RECORDS

Design: HGA Architects

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6/22/2016 10 DE DESIGN GN GOALS ALS

SAFETY-NET CLINIC CARE MODEL

DEVELOP DESIGN CONCEPTS THAT HONOR CULTURES AND ARE FAMILIAR TO PA TIENT POPULA TION

La Maestra Community Clinic Design: Richard Yen Associates Anchorage Native Primary Care Clinic Design: NBBJ

DE DESIGN GN GOALS ALS

CULTURAL SENSITIVITY

RESPECT FOR TRADITION VISUAL CUES AND SYMBOLS TO CREA TE SENSE OF PLACE INVOLVE PA TIENT ADVOCA TES ENVIRONMENT IS A SURROGA TE FOR QUALITYOF CLINICAL CARE

Anchorage Native Primary Care Center Design: NBBJ

DE DESIGN GN GOALS ALS

INTUITIVE WA YFINDING STRA TEGIES

SAFETY-NET CLINIC MODEL

EASY-TO-FIND DESTINA TIONS SENSITIVITY TO LITERACY INTUITIVE SPACE PLANNING LANDMARKS AS VISUAL CUES ACCESS TO NA TURAL LIGHT THROUGHOUT MAIN ARTERY CORRIDORS

Smiley’s Clinic Design: HGA Architects

DE DESIGN GN GOALS ALS

SAFETY-NET CLINIC CARE MODEL

CARE COORDINA TOR/ PA TIENT NA VIGA TOR: A BRIDGE TO OTHER RESOURCES

Red Rocks Medical Center Design: Boulder Associates

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SAFETY-NET CLINIC CARE MODEL

COLOR! PAINT IS CHEAP

Grace Hill Neighborhood Health Center Design: Arcturis Grace

DE DESIGN GN GOALS ALS

SAFETY-NET CLINIC CARE MODEL

USE OF COLOR GOOD LIGHTING CULTURALLY RELEV ANT ART--- CHILDREN GIVEN CAMERAS TO PHOTOGRAPH THINGS OF INTEREST

Hill Neighborhood Health Center Design: Arcturis RESTRUCTURING PRIMARY CARE

Physician working for patient, not insurance company Holistic management of preventative care & chronic conditions Integrative medicine/wellness focus Ease of access; longer appts. Physician as health coach Email consultations; remote monitoring Healthy Lifestyles THE FUTURE OF OF MEDICIN DICINE?

FOCUS ON PA TIENT ENGAGEMENT

RESTORE THE DOCTOR/PA TIENT RELA TIONSHIP OF THE PAST ENHANCE THE PA TIENT EXPERIENCE REMOVE TRADITIONAL BOUNDARIES BETWEEN PA TIENT AND PROVIDER

Design: Jain Malkin Inc.

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HOLISTIC HEALTH CARE

WELLNESS PHILOSOPHY INTEGRA TIVE MEDICINE

Design: Jain Malkin Inc.

RE RETAIL AIL CARE CARE MODEL

HOSPITALITY AND AMENITIES

SMALL SCALE “INTIMA TE” SETTING PA TIENTS DON’T WAIT LONGER APPOINTMENTS PA TIENT COMFORT IMPORTANT “LIVING ROOM” AMBIENCE

Design: Jain Malkin Inc. Exam rooms same-handed

IT Rich Environment

INN INNOVATION ON

High visibility , collaborative team environment

AMBULA TORY PRACTICE OF THE FUTURE

Open access to resources ANSHEN + ALLEN | STANTEC CIMIT

CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY

  • Remote conferencing and consulting
  • On-site or remote scheduling and check-in
  • Virtual visits, including remote monitoring

and automatic recording of vital signs to electronic medical records “Off-stage”

  • ffices
  • Employee health center for Massachusetts General Hospital
  • The patient as “expert” in their health needs receiving

proactive continuous healthcare and feedback

  • A total redesign of the outpatient care-experience
  • Model of care studied for impact on quality, cost, patient

and provider satisfaction

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INN INNOVATION ON

AMBULA TORY PRACTICE OF THE FUTURE

ANSHEN + ALLEN | STANTEC CIMIT

CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY

VIEWS OF BOSTON HARBOR A V ARIETY OF SEA TING TYPES NA TURAL LIGHT

INN INNOVATION ON

AMBULA TORY PRACTICE OF THE FUTURE

ANSHEN + ALLEN | STANTEC CIMIT

CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY

DESIGN EXAM ROOMS TO ENHANCE PA TIENT ENGAGEMENT “ANYROOM IS AN EXAM ROOM AND ANY ROOM IS A TALKING ROOM”

INN INNOVATION ON

AMBULA TORY PRACTICE OF THE FUTURE

ANSHEN + ALLEN | STANTEC CIMIT

CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY

DESIGN EXAM ROOMS TO ENHANCE PA TIENT/PROVID ER INTERACTION EXAM SIZE 10’ X 11’

INNOVATION ON

AMBULA TORY PRACTICE OF THE FUTURE

ANSHEN + ALLEN | STANTEC CIMIT

CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY

TEAM COLLABORA TION VISIBILITY TRANSPARENCY 5 EXAM ROOMS PER CARE TEAM

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INN INNOVATION ON

AMBULA TORY PRACTICE OF THE FUTURE

ANSHEN + ALLEN | STANTEC CIMIT

CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY

CENTRALIZED COLLABORA TION SPACE: A KEY CONCEPT IN THE PA TIENT- CENTERED MEDICAL HOME “EVERYBODY OPERA TING TO THE LIMIT OF HIS/HER LICENSE”

PARTNE TNERSHIP IP

PROJECT MANAGEMENT

Establishing a partnership Long-term investment Identifying shared goals Execute an action plan

CAPITAL PLANNING

Investor Design/Build Design/Bid/Build Lease

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ADEL ELANTE TE HEALTHCARE MESA

Design: Jain Malkin Inc.

DE DESIGN GN GOALS ALS

FACILITA TE ONE-STOP CARE

SAFETY-NET CLINIC CARE MODEL

Family Practice Pediatrics Internal Medicine Behavioral Health Dentistry OB-GYN Pharmacy Nutrition Café Community Room Health Education Podiatry Patient Navigator Naturopathic Medicine Physical Therapy Audiology

“WHOLE PERSON” CARE HIGH VISIBILITY MAJOR DESTINA TIONS

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Design: Jain Malkin Inc.

KEY DE DECIS ISIONS NS

CHANGE IS SCARY LOCA TION, LOCA TION, REPRESENTA TION DON’T GO NA TIVE…GO RET AIL PAINT $25 A GALLON MIX IT UP…GIVE MORE, GET MORE. A VISION

Design: Jain Malkin Inc.

KEY KEY DE DECISIO SIONS NS

ORGANIZA TIONAL CULTURE CHALLENGES

NONPROFIT VS. NOT-FOR-PROFIT TRANSITION FROM VOLUME–BASED REIMBURSEMENT SYSTEM TO QUALITY AND COORDINA TED CARE FOR A POPULA TION OWNING VS. RENTING FACILITIES PA TIENT- CENTEREDNESS

Design: Jain Malkin Inc.

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FQHC MODEL

TALKING ROOMS FLOW

Design: Jain Malkin Inc.

DE DESIGN GN GOALS ALS

AMENITIES TO SUPPORT FAMIL Y PRESENCE POSITIVE DISTRACTIONS INCREASE STAFF SATISFACTION

ADELANTE HEALTHCARE

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SERVIC VICES

PEDIA TRIC TALKING ROOMS

Design: Jain Malkin Inc.

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SERVIC ICES

Café Community Room

Design: Jain Malkin Inc.

Pharmacy

DES ESIGN GN GOALS

CHD PEBBLE SAFETY-NET CLINIC RESEARCH DESIGN FOR AMULTI- CULTURALCOMMUNITY CHD SAFETY

  • NET CLINIC

RESEARCH EASE OF WAYFINDING NATURALLIGHT SKYLIGHTS SMALL SCALE WAITING AREAS ENHANCE PATIENT- PROVIDER INTERACTION THROUGH DESIGN OF EXAM ROOM ALL LED LIGHTING LEED PLATINUM CERTIFICATION Design: Jain Malkin Inc.

PEBBLE E RE RESEA EARCH H AD ADELA LANTE NTE HEA EALTHC THCARE

POSITIVE DISTRACTION IN EXAM ROOMS

WILL PA TIENTS CHOOSE: NA TURE IMAGES? MUSIC WITH NA TURE? EDUCA TIONAL PROGRAMMING? CHOICES AUTOMA TICALLY RECORDED

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FY 2015

 45+K Patients  150+K Visits  $40+M Revenue  450+ Staff  Diverse Patient Mix 45% Medicaid (AHCCCS) 10% Medicare 10% Uninsured/Sliding Fee 10% Marketplace 25% Commercial  Locations: Central Support Office and 9 Health Center sites: West Phoenix, Mesa, Surprise, Peoria, Buckeye, Avondale, Wickenburg, Gila Bend, Central Phoenix

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RESOURCES FROM OM CHD

SAFETY-NET CLINICS WHITE PAPERS

A

  • wealth of information

Promising Practices in Safety-Net Clinic Design (Overview)

I

  • Designing Safety-Net Clinics for Flexibility
  • Designing Safety-Net Clinics for Cultural Sensitivity
  • Improving the Patient Experience
  • Designing Safety-Net Clinics for Innovative Care

DeliveryModels

Design & Construction Process Toolkit with interactive cost-benefit analysis feature (healthdesign.org/clinicdesign/MySNC)

Avein Saaty-Tafoya atafoya@ahcchc.com 602-463-5230 www.adelantehealthcare.com